Vaginal discharge Flashcards
What are causes of discharge?
Physiological: Pregnancy Sexual arousal Puberty COCP
Infection
Foreign body
What investigations for discharge?
Speculum examination and take vulvovaginal/endocervical swabs for chlamydia and gonorrhoea
What are infective causes of discharge?
Bacterial vaginosis Thrush Trichomoniasis Chlamydia Gonorrhoea
What are causative organisms of thrush?
Candida albicans
5 % candida glabrata
How does thrush present?
Red, fissured and sore vagina
Discharge is non-offensive white curds
What are risk factors for thrush?
Preganncy Contraceptive Steroids Immunodeficiency Antibiotics Diabetes - check BM
How is thrush diagnosed?
Microscopy (mycelia and spores)
Culture
What is treatment for thrush?
Topical clotrimazole pessary
Crea for vulva
Oral fluconazozle PO single dose
Candida glabrata may require topical nystatin or imidazole
Use topical regimen alone if pregnant or breastfeeding
What causes trichomoniasis? How does it present? Investigation? Management?
Trichomonas vaginalis
Vaginitis
Bubbly, thin, fish-smelling discharge - yellow/green, frothy
Strawberry cervix
pH > 4.5
Motile trophozoites on microscopy
Oral Metronidazole for 5-7 days
Treat partner too
What is the most common cause of discharge? Describe the discharge. Cause? Investigation?
Bacterial vaginosis
Thin, white, fiishy discharge - vagina is not inflamed, itching uncommon
Overcrowth of bacterial flora - Gardnerella vaginalis, Mycoplasma hominid, anaerobes
And too few lactobacillae
Raised vaginal pH > 4.5
Clue cells on microscopy
Vaginal pH >4.5
Positive whiff test - addition of potassium hydroxide results in ammonia smell
What are risks of bacterial vaginosis?
Increased risk of preterm labour
Intra-amniotic infection in pregnancy
Susceptibility
Post-termination sepsis
What is treatment for bacterial vaginosis?
Metronidazole PO
Clindamycin 2% vaginal cream
If recurrent treat partner
If pregnant, use oral metronidazole 400mg for 5 days
What are causes of discharge in children?
Infection from faecal flora
Associated with alkalinity from lack of vaginal oestrogen (prepubertal atrophic vaginitis)
Staphs and streps may cause pus
Exclude foreign body
What investigation in discharge in children?
Vulvual ± vaginal swab
MSU - glycosuria?
Examination under anaesthesia for prolonged or bloody discharge
What is management of discharge in children?
Discuss hygiene
Erythromycin antibiotic
